1. Field of the Disclosure
The disclosure includes a process for immediate implant placement and provisionalization of a maxillary lateral incisor with a chronic buccal infection and a defective buccal plate including harvesting autogenous bone from the mandibular symphysis area with a single vertical incision.
2. Description of the Related Art
Restoration in the anterior region of the mouth is challenging both from the surgical and prosthetic point of view. The goal of implant therapy today is not only to attain osseointegration of the implant but also to enhance and maintain the soft tissue esthetics around dental implants. Maintenance of the soft tissue architecture around the implant restoration to mimic the contra lateral tooth in the anterior esthetic area is a requirement for a successful restoration. Immediate implant placement and loading maintains the soft and hard tissue architectures, avoid need for additional surgeries, and shorten treatment time (Chen S T, Wilson T G Jr, Hammerle C H, “Immediate or early placement of implants following tooth extraction: Review of biologic basis, clinical procedures, and outcomes,” Int. J. Oral Maxillofac Implants. 2004; 19 (suppl): 12-25; Koh R U, Rudek I, Wang H L, “Immediate implant placement: positives and negatives,” Implant Dent., 2010 April, 19(2):98-108; and Lazzara R J, “Immediate implant placement into extraction sites: Surgical and restorative advantages,” Int. J. Periodontics Restorative Dent., 1989; 9:332-343—incorporated herein by reference). Clinical trials showed that a high success rate of the immediate implant placement in fresh extraction alveolus (Kan J Y, Rungcharassaeng K., “Immediate placement and provisionalization of maxillary anterior single implants: a surgical and prosthodontic rationale,” Pract. Periodontics Aesthet. Dent., 2000: 12(9): 817-24; Botticelli D, Berglundh T, Lindhe J., “Hard-tissue alterations following immediate implant placement in extraction sites,” J. Clin. Periodontol, 2004: 3 1:820-828; Chen S T, Darby I B, Reynolds E C, “A prospective study of non-submerged immediate implants: clinical outcomes and esthetic results,” Clin. Oral Impl. Res., 2007; 18:552-5623—incorporated herein by reference). Careful analysis of soft and hard tissue is prerequisite for an immediate implant placement in the anterior region of the mouth (Kois J C, Kan J Y., “Predictable peri-implant gingival aesthetics: surgical and prosthodontic rationales,” Pract. Proced. Aesthet. Dent., 2001; 13(9): 691-8—incorporated herein by reference). Kois named five diagnostic factors used to assist a predictable immediate implant placement (Kois J C., “Predictable single-tooth peri-implant esthetics: Five diagnostic keys,” Compend. Contin. Educ. Dent., 2004: 25:895-896, 898, 900 passim; quiz 906-897—incorporated herein by reference). Three of five diagnostic factors are the form, biotype of the periodontium and the height of the alveolar crest prior to the tooth extraction which addressed the importance of soft and hard tissue components. Presence of a chronic apical or periodontal infected residual socket may be considered as a contraindication for the immediate implant placements (Schwartz-Arad D, Chaushu G. Placement of implants into fresh extraction sites: 4 to 7 years retrospective evaluation of 95 immediate implants. J Periodontol 1997; 68:1110-1116—incorporated herein by reference). An infected alveolus confirms the presence of the bacteria that will induce inflammatory activity, increase the bone resorptive process and result in a higher risk of implant failure (Campos M I, dos Santos M C, Trevilatto P C, Scarel-Caminaga R M, Bezerra F J, Line S R., “Early failure of dental implants and TNF-alpha (G-308A) gene polymorphism,” Implant Dent. 2004; 13:95-101—incorporated herein by reference). Lindeboom et al. compared the survival rate of immediate and delayed implant placement into infected residual alveolus (Lindeboom J A, Tjiook Y, Kroon F H., “Immediate placement of implants in periapical infected sites: A prospective randomized study in 50 patients,” Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 2006; 101:705-710—incorporated herein by reference). The author showed a 92% survival rate of immediately placed implants compared with a 100% survival rate of delayed placement implants. Additionally, there was more mid-buccal soft tissue recession in the immediate placement compared with the delayed placement protocol one year after placement. In another study by Seigenthaler et al. demonstrated an equal survival rate of the immediate and delayed implant placement into infected socket (Siegenthaler D W, Jung R E, Holderegger C, Roos M, Hammerle C H., “Replacement of teeth exhibiting periapical pathology by immediate implants: A prospective, controlled clinical trial,” Clin. Oral Implants Res., 2007; 18:727-737—incorporated herein by reference). Complete debridement of the alveolus with a primary stability of the implant is prerequisite for immediate placement. Immediate placement of an implant in presence of a chronic infection with a deficient buccal plate in a patient with a high smile line is very challenging and complex. Autogenous bone graft harvested from intraoral or extraoral sites has been used for predictable guided bone regeneration (Misch C M, Misch C E., “The repair of localized severe ridge defects for implant placement using mandibular bone grafts,” Implant. Dent., 1995 Winter; 4(4):261-7; and Pikos M A., “Mandibular block autografts for alveolar ridge augmentation,” Atlas Oral Maxillofacial Surg. Clin. N. Am., 2005; (13):91-107—incorporated herein by reference). There are certain complications of the donor sites have been reported (Toscano N J, Shumaker N, Holtzclaw D H., “The Art of Block Grafting: A review of the surgical protocol for reconstruction of alveolar ridge deficiency,” J. Implant. Adv. Clin. Dent., 2010; Vol. 2, No. 2; Misch C M., “Comparison of intraoral donor sites for onlay grafting prior to implant placement,” Int. J. Oral. Maxillofac. Implants, 1997; 12:767-776—incorporated herein by reference).
A surgical process and the restorative protocol for an immediate implant placement and provisionalization in the presence of large periodontal abscess with a buccal plate defect in a highly esthetic demanding area is described by harvesting an autogenous mandibular symphysis graft harvested with a single vertical incision.
Autegenous bone graft has been used as a gold standard for grafting procedure due to the osteogenic, osteoinductive, and osteioconductive capacity. Intraoral harvested bone from mandibular symphysis can be used for predictable guided bone regeneration (GBR). The increase of popularity of using the mandibular symphsis as a donor sites is due to the Local availability of the donor sites eliminate need for extraoral sources, up to 10 cc of Cortico:cancelious bone graft can be harvested, and a predictable bony gain up to 6 mm in horizontal and vertical dimensions. However, while the mandibular symphysis has many advantages, there are some complications of using such technique making it less attractive for dental practitioners. Post-operative morbidity and patient discomfort have been reported as a major concern of harvesting bone from the mandibular symphysis. Misch reported that 29% of patients reported alter lower incisors sensation, 9.6% had a paresthesia for up to six months, and 10.7% had incision dehiscence at the donor site. Chin ptosis is also a concern due to the disturbance of the muscle attachments due to bone harvesting from the mandibular symphysis area.